August 19, 2013

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(August 19 -- By David Siders, dsiders@sacbee.com)

A majority of California voters remain unflinching in their support of the federal health care overhaul, though nearly half of the electorate predicts it won't affect them much, according to a new Field Poll.

Forty-six percent of California voters - a plurality - say they do not expect to be much better or worse off when the law is fully enacted, according to the poll. Of those who do expect their families to be affected, 23 percent predict they'll fare better, 26 percent worse.

The poll, sponsored by the nonprofit California Wellness Foundation, comes as the state prepares to implement major changes under the law next year, including a requirement that nearly all Americans carry health insurance or pay a penalty.

Public opinion about the law has remained virtually unchanged since its enactment in 2010 and is reflective of California's heavily Democratic tilt: Registered voters support the law 53 percent to 38 percent, with large majorities of Democrats and liberal voters in favor and large majorities of Republicans and conservative voters opposed.

The law enjoys greater than 2-1 support in California's left-leaning population centers, in and around Los Angeles and San Francisco, while pluralities of voters oppose the act in inland, more conservative reaches of the state.

Voters under 30 support the controversial law 63 percent to 27 percent, while voters 65 and older are more evenly divided, with 47 percent in favor and 43 percent opposed, according to the poll.

"This law is just highly charged politically," said Mark DiCamillo, director of the poll. "People have their opinions on it and are pretty stable. They haven't changed over time."

The public is only marginally more knowledgeable about the law than it was two years ago. Just 15 percent of registered voters say they are very knowledgeable about specific changes to the health care system contained in the law, a 4 percentage point increase over 2011, according to the poll.

Sixty percent of voters say they are somewhat knowledgeable, a 7 percentage point increase in the last two years, according to the poll.

"It's pretty confusing," said Dennis Montgomery, a rice farmer from Glenn. "I don't really know what's going on, but I like the idea. I mean, everybody ought to have affordable health care."

Montgomery, a 62-year-old Democrat, said he has been without health insurance since 1989, when he hurt his back and quit working at a saw mill.

He said he probably will sign up for insurance on the exchange but that, "I'm pretty much confused now. It's like, if they could get a mail-out thing from the government, that's what they need ... a little catalogue or something."

The public's still-middling knowledge registers less than two months before state health care exchanges open for enrollment in October. Covered California, the state exchange, expects about 2.3 million Californians to enroll in a health plan through the exchange by 2017, and it will spend millions of dollars on outreach and marketing.

Public support for the health care law remains steadfast in California despite flagging support for President Barack Obama, whose approval rating in the Golden State plummeted to 52 percent last month, a 10 percentage point drop from February, according to the Field Poll.

The health care law is considered the most far-reaching legislative achievement of his presidency.

About two-thirds of California voters say the law is likely to significantly reduce the ranks of California's uninsured and to include greater protections for consumers, according to the poll. Sixty-two percent of voters support the state's expansion of Medi-Cal coverage to more than 1.6 million low-income Californians by 2015 under the federal law.

However, even in deep-blue California, concerns about the effects of the law persist.

Fifty-seven percent of registered voters say it is likely seniors enrolled in Medicare will see their health benefits reduced as a result of the law, and 54 percent of voters say people who are currently insured will likely be forced to change their health plans or doctors, even if they don't want to.

Public opinion about what action, if any, Congress should take on health care mirrors voters' overall opinion of the law, with 51 percent of voters in support of keeping or expanding the law and 38 percent wanting to repeal part or all of it.

Glenn Felder, a Republican from Red Bluff, said the health care law is an affront to his free-market principles.

"I believe in our intended capitalistic system of government, that you work and provide for yourself," said Felder, who owned a title insurance and escrow company before retiring in 1995. "And during my lifetime, I'm 74 now, I've seen it swaying from where a person was dependent on themselves to where you're dependent on the government."

California became the first state in the nation to enact legislation establishing a public health insurance marketplace, and Covered California this month announced a list of insurance companies that have signed contracts to sell health plans on the exchange.

Alan Barnes, a Democrat from Carmichael, intends to enroll. The 47-year-old lawyer said he has been uninsured on and off for 13 years, ever since he opened his own law firm.

Because he and his wife and two teenage daughters are relatively young and healthy, Barnes said, he feels a responsibility to participate in an exchange that depends on healthy enrollees to contain costs. Furthermore, Barnes said, "It's a little bit scary ... If I contract cancer or have a heart attack, and suddenly have hundreds of thousands of dollars in medical bills, we're bankrupt."

The health care overhaul puts much of the responsibility for enactment on state governments. California voters by a nearly 2-1 margin say they trust state government more than the federal government to implement the law.

However, 15 percent of voters volunteered they trust neither the state nor federal government to implement the law, though they were not presented with that response as an option.

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